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Objective The objective of this cadaveric biomechanical study was to compare the area of the foraminal space during motion in the intact condition, after direct decompression via foraminotomy, and after indirect decompression via anterior lumbar interbody spacer insertion. Methods Eight (8) L5-S1 cadaver specimens were used for testing. Each specimen was tested in the intact state, after posterior foraminotomy, and after standalone anterior lumbar interbody fusion (ALIF). Each specimen was 3-dimensional imaged under neutral loading, flexion, and extension. The 3-dimensional images were analyzed for changes in the foraminal area under each loading scenario. A repeat-measures design was used. Outcome measures from testing included the frequency in which an increase in cross-sectional area was observed, as well as the percent increase of the foraminal area for each surgical group and loading direction. Results Direct foraminotomy and ALIF maintained the foraminal space during initial distraction under no loading with areas 99.7% and 96.5% of the native foraminal area, respectively (P = 0.955 and P = 0.455). Direct foraminotomy increased the foraminal area significantly during flexion to 112.2% of the area before motion (P = 0.008) while ALIF did not. Direct foraminotomy significantly decreased the foraminal area during extension to 89.2% of the area before motion (P = 0.006). ALIF, however, maintained its initial distraction during extension with 98.2% of the area before motion (P = 0.808). Conclusions ALIF maintains the foraminal area in extension while direct posterior foraminotomy does not.

Study design In vitro cadaver biomechanics study. Objective The goal of this study is to compare the in situ fatigue life of expandable versus fixed interbody cage designs. Summary of background data Expandable cages are becoming more popular, in large part, due to their versatility; however, subsidence and catastrophic failure remain a concern. This in vitro analysis investigates the fatigue life of expandable and fixed interbody cages in a single level human cadaver corpectomy model by evaluating modes of subsidence of expandable and fixed cages as well as change in stiffness of the constructs with cyclic loading. Methods Nineteen specimens from 10 human thoracolumbar spines (T10-L2, L3-L5) were biomechanically evaluated after a single level corpectomy that was reconstructed with an expandable or fixed cage and anterior dual rod instrumentation. All specimens underwent 98 K cycles to simulate 3 months of postoperative weight bearing. In addition, a third group with hyperlordotic cages was used to simulate catastrophic failure that is observed in clinical practice. Results Three fixed and 2 expandable cages withstood the cyclic loading despite perfect sagittal and coronal plane fitting of the endcaps. The majority of the constructs settled in after initial subsidence. The catastrophic failures that were observed in clinical practice could not be reproduced with hyperlordotic cages. However, all cages in this group subsided, and 60% resulted in endplate fractures during deployment of the cage. Conclusions Despite greater surface contact area, expandable cages have a trend for higher subsidence rates when compared with fixed cages. When there is edge loading as in the hyperlordotic cage scenario, there is a higher risk of subsidence and intraoperative fracture during deployment of expandable cages.

Object Expandable cages are becoming more popular due in large part to their versatility, but subsidence and catastrophic failure remain a concern. One of the proposed reasons of failure is edge loading of the endplate caused by a mismatch between the sagittal alignment of the motion segment and cage. This in vitro analysis investigates the endplate forces characteristic of expandable and fixed interbody cages in a single-level human cadaver corpectomy model. Methods Ten human thoracolumbar spines (T10–L2, L3–5) were biomechanically evaluated following a single-level corpectomy that was reconstructed with an expandable or fixed cage. Fixed cages were deployed with the best-fitting end cap combination, whereas expandable cages were deployed in normal, hypolordotic, and hyperlordotic alignment scenarios. The endplate forces and contact area were measured with a pressure measurement system, and the expansion torque applied by the surgeon was measured with a custom-made insertion device. Results The contact areas of the expandable cages were, in general, higher than those of the fixed cages. The endplate forces of the expandable cages were similar to those of the fixed cages in the normal alignment scenario. Higher endplate forces were observed in the hyperlordotic scenario, whereas the endplate forces in the hypolordotic and normal alignment scenarios were similar. There was no correlation with the expansion torque and the final endplate forces. Conclusions Expandable cages resulted in consistently higher contact area and endplate forces when compared with the fixed cages. Because the expansion torque does not correlate with the final endplate forces, surgeons should not rely solely on tactile feedback during deployment of these cages.

Both expandable and non-expandable interbody cage designs are available to surgeons for cases involving spinal reconstruction and stabilization following single level lumbar corpectomy [1]. Different expandable cage designs are on the market [2], but all involve a manual mechanism to intraoperatively adjust the compressive load applied by the cage against the vertebral body endplates. Non-expandable cages do not have such a mechanism, and surgeons rely on cutting the cage to the appropriate length to achieve a “press-fit.” The clinical reasoning behind the expandable cage design is that the adjustability of the device will allow the surgeon to achieve the maximum contact area between the cage and the vertebral endplate without “overstuffing” the interbody space and thus causing a sagittal-plane deformity.Copyright © 2010 by ASME